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You Got the Contract! …NOW WHAT?! A Short Series

Published in VGM Government Relations on August 05, 2025

By Melanie Ewald, VP of Payer Relations and Reimbursement 

Congratulations! You FINALLY got the contract you’ve been working so hard on all these months. Now that you have it, what are the critical next steps you need to take to maintain and implement the contract and generate ROI? Welcome to the first of a short series of articles to help you accomplish just that.  

Contracts can be anywhere from 8 to 100+ pages in length with many sections often written in legalese. We recommend that you familiarize yourself with every section of the contract to make sure you understand your obligations, the payer’s obligations, your rights under the contract and what it does and doesn’t cover. With that said, we realize that you may have questions about what you really need to know out of all those pages. Below is a brief non-exhaustive summary of a few key provisions you should be certain you understand about your contract. 

Reimbursement – In addition to outlining the rate amount, methodology or specific fee schedule, when, and how you will receive payment, the contract should also include a provision that allows providers to renegotiate the reimbursement provision in certain circumstances defined in the contract. 

Notifications – For what and in what time frame are you required to notify the payer should something change for your business. For example, you have a change in ownership. Does the payer require you to notify them before the change occurs or within a certain number of days after the change? 

Initial Term and Renewal – Typically, initial contract terms are for 1-2 years and then the contract automatically renews continuing indefinitely until one party terminates it within a specified notice period prior to the end of the contract cycle or year. These types of automatic renewal clauses are known as an “evergreen.” For long-term contracts where continuity is critical, there is often a renewal period of 30-60 days before the contract auto-renews. 

Termination – The contract should state the specific instances when termination is allowed. One critical instance is when the payer fails to issue payment. Contracts often allow either party to terminate the contract without cause upon prior written notice to the other party. The contract should state when the effective date occurs in these instances, normally a specific number of days after written notice is received. 

Data – What does the contract say about patient and claims data and the protection of it? What is each party responsible for in relation to the data? 

Amendments – The contract should provide details around unilateral amendments versus mutual agreement. Unilateral amendments allow payers to issue an amendment and require providers to accept it or give notice of termination within a specified time frame. Mutual agreement allows for the provider and payer to negotiate the amendment or contractual change.

Again, the above are some, but certainly not all, of the provisions you should be intimately familiar with once you execute a contractor with a payer. Knowing this information will be extremely helpful as you transition from pursuing to maintaining your payer contracts…a topic we will cover in the next article.  

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